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Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

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Date ____________________

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Medical History

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Family History

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Voted Best Chiropractor in North Georgia

THIS ---->https://watkinstotalhealthcarecom.chiromatrixbase.com/new-patient-center/new-patient-health-history-form.html

Office Hours

DayOpenClosed
Monday8am6pm
Tuesday8am6pm
Wednesday8am6pm
Thursday8am6pm
Friday
Saturday
Sunday
Day Open Closed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8am 8am 8am 8am
6pm 6pm 6pm 6pm

Testimonial

Best of the Best ! I would recommend anyone to this wonderful staff. I went in with so much pain, after a few visits I felt so much better, it was then that I realized just how much pain I was actually in. I'd give them 10 stars if it would go above 5!

Sam H.
Gainesville, GA

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